A national drug shortage, affecting everything from cancer therapies to antibiotics to pain medications, has Delaware health care providers scrambling to find alternatives, and in some cases patient care has been delayed or less effective drugs have been used.
“It’s coming to a crisis point,” said Kimberly Couch, clinical pharmacist at Nanticoke Health Services in Seaford, adding there is a scarcity of chemotherapy drugs, antibiotics and some medications used for heart problems. “People are getting the care they need but it definitely makes the logistics for care a lot more difficult for patients.”
Shortages of drugs, she continued, have been a problem for some time but the situation has come to a head in the last month or so. “Unfortunately, sometimes care has to be delayed for patients,” she said. “Most of the time we can substitute something else or find something else that will work for the patients. But now we’re facing fewer and fewer options.”
Christiana Care Health System in Newark is doing “extraordinary things in order to obtain products,” said Scott Samples, director of pharmacy operations. The hospital, he added, is doing “everything possible to make sure the drug shortage doesn’t negatively impact care.”
Drug shortages have existed for the last ten years or so but have recently skyrocketed, with the list of scarce medications tripling since 2006, according to the American Society of Health-System Pharmacists. “It’s become our first priority in the last few months, our number one issue,” said Joseph Hill, director of federal legislative affairs for the group, especially shortages in the area of medications for oncology, anesthesiology and pain.
There are approximately 200 medications in short supply throughout the United States, according to the Society, and Delaware government officials are monitoring the situation.
“It’s not a public health disaster or emergency but it’s something we’re aware of and we’re looking at ways to solving the problem,” said Dr. Rick Hong, medical director for public health preparedness in Delaware’s Division of Public Health.
Hong said he’s been communicating with Delaware health care providers and said there have been no reports yet of any adverse impact on patients or procedure cancellation as a result of the shortage. “It’s something we need to keep an eye on,” he added.
Indeed, the shortage is beginning to cause problems nationally, particularly in acute care, said Allen Vaida, executive vice president of the Institute for Safe Medication Practices in Horsham, PA.
“There are safety issues and errors are happening,” he said about the shortage, which has been a problem for a few years but reached a critical point last year. Errors occur, he explained, because “of the use of alternative medications if they exist. Alternatives may have different doses, or may have to be prepared differently or stored differently especially in acute care settings. Hospitals aren’t finding out about many of these drug shortages until the last minute so there’s not a lot of prep time, or time to talk about it with medical staff.”
The Institute conducted a survey of 1,800 health care practitioners in September and found many were “alarmed by the ever-increasing volume of critically important medications in short supply, and the resulting use of less desirable, unfamiliar alternative drugs where available.”
The survey also showed:
- About 35 percent of those polled said their facilities experienced a near miss medication error that could have harmed the patient as a result.
- About one in four reported actual errors; and one in five reported adverse patient outcomes during the past year due to drug shortages.
Hong and officials at two major hospitals in the First State said no adverse impact on patients has resulted, but health care providers appear to be taking great pains to communicate and educate their medical staff on how to deal with alternative drugs and dosages.
Samples said, “the pharmacy works closely with medical staff, around everything related to medication. We’ve taken a lot of steps to proactively communicate amongst medical staff, leadership, as well as nurses. We have a pharmacy and therapeutics committee that overseas the medication-use process.”
In addition to some chemotherapy medications being scarce, the drugs that are in shortest supply at Christiana Hospital now are Lasix, a diuretic; dexamethasone, a steroid; and an antibiotic called trimethoprim/sulfamethoxazole. But Samples stressed the hospital has been able to find safe and effective alternatives, and that there’s been no rationing of drugs as a result. “We have worked hard from a pharmacy standpoint to creatively address supply sources,” he said, including reaching out to a medical center in Philadelphia for supplies.
Dr. Stephanie Lee, an infectious disease specialist who’s in private practice and works for both St. Francis and Christiana Hospital said she’s had to use drugs she thought were not as effective. She pointed to a drug used to treat bacterial infections called Bactrim, which is administered intravenously.
“We have seen shortages of IV Bactrim. While some hospitals were able to stockpile their supplies, others did not have it in stock,” she said. “We are giving oral Bactrim as an alternative, but this is not always a good option in the critically ill who cannot absorb medicines through the gut.”
At Beebe Medical Center in Lewes, there’s now a full-time employee whose job it is to check the computer for medication supplies every ten minutes, said Sam Roberts, director of pharmacy for the center.
“The last year has been very difficult,” he said about the drug shortage, stressing that despite the scarcity of some medications “we’ve had the advantage of not running out of anything.” But he’s been forced to buy some products from so called gray market resellers who charge hefty prices for scarce drugs, and that means the hospital has had to spend an extra $100,000 on medication already this year.
The biggest problem for Beebe has been getting intravenous narcotics used to treat pain, said Roberts. “We’ve had to do a lot of manipulating and preparing of things in pharmacy,” he said. “It’s much more labor intensive. We tell physicians we’re having problems getting this. We are judicious in the way we use things.”
Even though shortages in medication are nothing new for the medical world, the limited supplies recently are unlike anything seen before. What’s driving the problem is a host of factors that have converged to create a “tipping point,” said Vaida, paying homage to the famous book “The Tipping Point,” by Malcolm Gladwell.
International turmoil has affected supply because 80 percent of the raw materials for many drugs come from overseas, including China and India, he explained. There has also been a consolidation in the pharmaceutical industry, Vaida continued, and some manufacturers have opted to stop making certain drugs because they just weren’t as profitable as they’d hoped.
Unfortunately, there is no government agency or medical board that has the authority to make sure manufacturers don’t just stop producing critical drugs used in the United States without notice, he said.
There is legislation, he pointed out, sponsored by Sen. Amy Klobuchar, (D-MN) and Sen. Robert Casey (D-PA), that would give government more authority in this regard. Senate bill 296 known as the “Preserving Access to Life-Saving Medications Act” would give the FDA tools to help stem such drugs shortage in the future.
Senator Tom Carper (D-DE) recognizes the importance of efforts to address the problem of drug shortages.
“Sen. Carper is committed to ensuring that Delawareans can access life-saving medication in a timely manner. He’s currently studying S. 296’s approach and other policies that will address concerns regarding reported drug shortages,” said Carper spokeswoman, Emily Spain.
For patients who are worried about the types of medications they’re getting now, Vaida suggested communicating with your physician and finding out whether you are getting the drugs you’ve used before, or if you feel you’ve had an unusual reaction to a medication. Patients can also contact the Delaware Division of Public Health, or contact the FDA here.
But for now, “it’s not affecting patient care,” stressed Hong. “We’re working closely with hospitals so it doesn’t come to a situation where patient needs aren’t met.”
